Should blood doping be legal in sport?

Ever since 100 Russian athletes were banned from competing in the 2016 Summer Olympics for doping, the eyes (and ears) of the sporting world have been fixated on what will happen next.

If everyone is doping, then it isn't cheating, but levelling the playing field

Mike Miller, the chief executive of the World Olympians Association, has a solution. In an Orwellian twist, he wants to take athletes under scrutiny and microchip them to monitor changes in their body. After all, if you have nothing to hide, you have nothing to fear.

Perhaps this is a bit extreme, but who knows? Whether cybernetic or chemical body alteration wins out, maybe performance enhancement is the future of sport. MH investigates.

It remains one of the most enduring scenes in Tour de France history. Tyler Hamilton, aged 32 and on his seventh Tour, grits his teeth as he sprints away from a 12-man breakaway group at the front of the race.

For two weeks, he has been riding with a double fracture in his right collarbone, the product of a nasty crash. Yet, after suffering through his five-hour 198km ordeal on the road from Pau to Bayonne, Hamilton is leading the pack by four whole minutes. Wiping tears of pain from his face on the climb, he nevertheless sails into a comfortable first place. As a spectator it’s nigh on impossible not to be swept up by the emotion of the occasion.

One year later, in 2004, Hamilton tested positive for blood-doping. He received a two-year ban and, after a short-lived comeback, retired from the sport in a cloud of ignominy. He later admitted that, on the night before his heroic effort up to Bayonne, he had injected a bag of his own red blood cell-enriched blood.

By the letter of the law, Hamilton was a cheat. His teammate Armstrong, who would go on to claim overall victory, was also a cheat. Then again, so was the rider who finished second. In fact, of the top 10 finishers of the 2003 Tour, only two men have never served bans for doping. In his autobiography, The Secret Race, Hamilton would later write, “You can call me a cheater and doper until the cows come home. But the fact remains that in a race where everybody had equal opportunity, I played the game and I played it well.”

He’s not the only one playing. Cycling has been under suspicion since 1999, with 90% of blood collected before that year’s Tour reportedly classified ‘suspicious’. And with both Nike and the UN distancing themselves from Maria Sharapova after she tested positive for banned substance meldonium at the Australian Open in January, as well as allegations levelled against Mo Farah’s coach Alberto Salazar – not to mention the state-sponsored doping endemic in the Russian Athletic Federation – it’s clear that doping culture in sport is as rife today as it’s ever been.

Yet some supporters question whether athletes like Sharapova and Hamilton are the villains anti-doping purists make them out to be. After all, when most of your rivals are injecting EPO – erythropoietin, a hormone stimulating red blood cell production, thereby increasing the amount of oxygen available to the muscles – it’s arguable that to race clean would be to guarantee defeat. It’s the same embittered line Lance Armstrong has maintained since he was stripped of his titles and his dignity in 2012: if everyone is doping, taking performance- enhancing drugs (PEDs) isn’t cheating; it’s the only way to level the playing field.

British heavyweight boxing champion Tyson Fury has never fallen foul of anti- doping authorities. But he has seen the way the physiques of others in his sport have changed, and knows that by not doping the odds are stacked against him. “Why don’t they make drugs totally legal? Then everybody would be taking drugs and it would be fully fair,” he posited ahead of his title fight against Wladimir Klitschko last November. “You’ve got all these people taking drugs, and when they face a man who’s not taking drugs, that man’s at a disadvantage.”

It’s a controversial viewpoint, and all the more punchy coming from a top athlete with a spotless record (albeit one with a mouth some might say is quicker than his brain). But isn’t it worthy of consideration? Instead of trying to root out wrongdoers, why don’t we simply open up doping to everyone? If we all compete using the same substances, wouldn’t that, in the end, be truly fair?

Blood Sports: Doping by numbers

95%

of blood-doping cyclists are male, according to MPCC* stats for 2015

24%

of 2015’s doping cases occurred in athletics: the most doped sport

21%

of cases occurred within weightlifting: the 2nd most doped discipline

7.8%

of doping originates in the UK, following the US (8%) and Russia (15%)

Dope Boys

Anti-doping is an expensive business. In 2015, the World Anti-Doping Agency (WADA) had an operating budget of $27.6 million. It might seem a large figure, but considering it’s equivalent to the total Wimbledon prize money, and much lower than a Premier League football team’s annual wage bill, incentives to cheat across all sports remain far greater than the chances of getting caught.

To date, WADA has had little success in combating doping, with only 2% of all blood and urine samples collected each year resulting in positive tests for banned substances. By most experts’ estimates, the true number of dopers is anywhere between 14% and 39%.

Tom Bassindale, a senior lecturer in forensic and analytical science, spent six years working in WADA’s London laboratory, on the front line of anti-doping. His work has given him unparalleled insight into why cheats slip through the net. “They know testers are going to turn up at a competition and that if they stop using whatever drugs they’re on three to four weeks beforehand, it’s unlikely they’ll get caught,” he says, matter-of-factly. As avoidance strategies go, it’s hardly rocket science.

To deter dopers, WADA has upped its level of out-of-competition testing. Its reps now turn up at athletes’ homes or gyms at any point over the course of the year. But athletes can – and often do miss these tests, whether by accident or design. “You get three strikes within a year,” Bassindale explains. “If you miss three drugs tests, you’re banned. But, if you only happen to miss two, your slate is wiped clean after 12 months.”

It’s unsurprising that due to the ever-evolving nature of doping, WADA and its affiliate agencies are constantly playing catch-up. Each time a new test is introduced, dopers come up with a more sophisticated drug or method of avoiding detection. In an attempt to combat this, WADA introduced the ‘biological passport’ in 2009; samples were taken from athletes over time, making it easier to spot spikes in performance. The system has since been exposed for its many flaws, most notably the difficulty of detecting microdosing.

“If you only use a small amount of EPO every day, instead of two big doses a week, then those values that are being monitored won’t fluctuate much. Yet the changes in terms of your oxygen-carrying abilities will be very real – and very useful,” says Bassindale.

Evidently, anti-doping in its current guise isn’t working. And the answer, according to a growing number of voices in and around the sporting world, is not to embark on the Sisyphean task of stringently regulating all sports, but to lose the incredibly expensive, logistically complex regulations altogether.

Nature vs Nurture

Enhancement, in one form or another, is nothing new. For as long as tests of athletic ability have existed, those taking part have sought to gain any available advantage. In ancient Greece distance runners would smear their bodies in olive oil to stay hydrated (badly burning themselves in the process).

Today, our approach is considerably more scientific. Take a professional cyclist such as Chris Froome. Every gram of food that enters his mouth is measured to ensure an optimal macro-nutritional profile. His £12,000 carbon fibre bike has been through hundreds of hours of wind tunnel testing to ensure aerodynamic efficiency. His riding position, cadence and helmet are analysed and optimised. It’s all entirely within the rules. Yet how much of his success can be considered natural, and how much is technological?

“Athletes are in the business of attempting to transcend human limits,” says professor Andy Miah, a bioethicist at the University of Salford, and author of Sport Technology. He argues that rather than holding on to the antiquated idea that sporting greatness is the product of some kind of organic perfection, we need to acknowledge technology’s role. “Especially at the elite level, sport is inherently a relationship between technology and nature,” he says.

The water is further muddied by the fact that the thinking behind which substances should be banned is in flux. After a spell on the wrong side of the law, caffeine, despite not being found naturally in the human body, is now on WADA’s safe list. “Caffeine is a proven performance enhancer, yet reversing the ruling on it has done nothing to affect the spectacle, nature or definition of sport,” says Julian Savulescu, professor of practical ethics at Oxford University. “It just means we don’t have to waste time working out how much Coca-Cola an athlete’s drunk.”

Conversely, dabbling with steroids, EPO or HGH – which are found naturally inside our bodies – remains prohibited. For Savulescu, this comes down to form over function. “If something comes in a plant, it’s OK. If that same substance is distilled into a pill, it’s objectionable. And if it is put into an intravenous drip, well, that’s the same as taking crack cocaine and needs to be banned – even though it’s the same physiological substance.”

A Clean Pill of Health

By complicating the rules, Miah claims WADA has failed at one of its key stated aims: to protect the health of athletes. Its list of prohibited substances, he argues, fuels a PED black market. Instead, Miah advocates that pharmaceutical advances should be legalised and regulated. “Sports organisations have a moral obligation to ensure that they are investing in the safest forms of performance enhancement for athletes,” he says. “Managing the health and safety risks associated with performance enhancement – that’s the priority.”

However, for most fans (and governing officials), the focus is on fairness, rather than the wellbeing of dopers. As Verner Møller, professor of sports science and health at Aarhus University, pointed out at last year’s International Network of Humanistic Doping Research, “If 99% of athletes abstain from doping, that then makes doping all the more advantageous for the remaining 1%.” It’s the anti-doper’s paradox: the more cheats we catch, the better off the uncaught ones will be.

Follow this chain of thought through to its logical conclusion (as Savulescu has) and the only way to guarantee everyone has the same advantages is to legitimise PEDs. “Doping is not against the spirit of sport,” says Savulescu. “If you’re taking steroids and somebody else isn’t, that is unfair. However, if you allow people to take the same doses of steroids – within safe limits – that wouldn’t be unfair.”

A Battle of Wits

Dr Olivier Rabin, WADA’s director of science, is the man tasked with keeping pace with the increasingly sophisticated strategies employed by dopers. For Rabin, the argument that allowing doping would increase fairness isn’t that simple. “If you need to take a pill to compete at the level of people who do not take a pill, then when the ones who don’t currently take pills begin to do so, they’ll still be ahead of you.” Essentially, by legalising PEDs you wouldn’t so much be levelling the playing field as jacking up the existing one.

“It would be really sad for sport,” says Dr Richard Budgett, a member of the coxed four rowing team, alongside Sir Steve Redgrave, that won gold at the 1984 Olympics. Budgett is now the medical and scientific director of the International Olympic Committee. “A lot of athletes would withdraw from sport if they had to use drugs in order to compete. It would marginalise elite sport.” Far from being democratic, the open use of PEDs could be like holding a gun to the head (or needle to the arm) of anyone wanting to compete.

What’s more, Rabin believes that whatever level of doping you allow under this new, anything-goes system, it’s human nature to find ways to cheat. “If you take away limits,” Rabin says, “athletes will become guinea pigs, with scientists and physicians choosing the most efficient molecule or technology.”

The athlete as lab rat – a living experiment that a team of nutritionists, scientists and engineers are looking to advance and exploit – sounds faintly terrifying, but not a million miles away from the top-level experience today. Under so much pressure, is it any wonder athletes look for extra help?

Club PED

Tyler Hamilton still vividly remembers his initiation into the world of doping. “Five months into my first season at the top level is when I got invited into that secret fraternity.” He recalls paper bags stuffed with PEDs being openly handed out to riders. “It started out slowly, and next thing you know, a few years later, you’re crossing borders with performance- enhancing drugs, taking major risks,” he says. “It wasn’t a lot of fun. But you felt you had to do it, because the other guys were.”

Under the influence of a potent cocktail of prohibited substances, Hamilton won stages of the Tour de France, the US National Championships and an Olympic gold medal. Yet he never felt able to take pride in his achievements: “I wasn’t proud of my results anymore and I hated it when people put me on a pedestal,” he says.

You might think someone whose victories came via an intravenous drip might back the notion of a World Pro-Doping Agency. But Hamilton has become an outspoken supporter of WADA and its mission. “I understand the argument [of people like Savulescu], and I’ve heard it many times, but if we legalise these substances, what’s that telling the younger generation?” he asks.

Hamilton’s decade of substance abuse led to a lifetime ban, severe depression, and the breakdown of his marriage. He refuses to accept that the future of sport should lie in the barrel of a syringe.

“Maybe some kid aspires to be like Lance, or me. They know we’re doing X, Y and Z and they’re going to want to do the same. People buy Snickers because of their favourite basketball players – it’s the same thing.” The question of fairness lies at the very heart of sport. From cricket to shotput to downhill skiing, all sports are wrapped in a series of arbitrary regulations. Without rules, it’s not sport – just people in shorts running around in a sweaty free-for-all.

But rules change. Sometimes evolution is triggered by a shift in technology, other times by physical improvements in the athletes themselves. In the ’90s, a combination of new racket tech and increasingly powerful players led to an inordinate number of aces being served in men’s tennis. The International Tennis Federation was so concerned that people would be turned off by the lack of rallies that they considered everything from raising the level of the net to increasing the size of the balls. As the sporting world changes, the rulebook must either adapt with it, or be abandoned. And so it is with PEDs.

Then again, sport, by its very nature, is not about equality, but about celebrating those who stand out. Records – and human limits – are there to be broken. To what extent, then, does the fabled “level playing field” exist? If fairness comes down to either everyone hooking up to an IV, or no one, surely the latter is more palatable. “It’s not an easy fight,” says Hamilton. “We could be talking in 2025 and things still might not be much different. But we can’t give up. We’ve got to keep fighting. And gritting our teeth.”

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